Surgical tool position tracking and scoring system

ABSTRACT

A system and method for tracking position and orientation of a surgical tool during a surgical procedure and providing feedback to a user are described. For example the system includes a surgical tool configured to perform at least a portion of the surgical procedure, a tracking system configured to monitor and record position information related to the surgical tool, a processing system, and a display. The processing system can be configured to receive the position information, determine optimal position information for the surgical tool during the surgical procedure, compare the received position information against the optimal position information to determine a conformance level for the user, and generate a user performance record. The display can be configured to receive and display the user performance record.

CROSS-REFERENCE TO RELATED APPLICATION

This application claims the benefit of priority to U.S. ProvisionalApplication No. 62/508,839 titled “Surgical Tool Position Tracking andScoring System,” filed May 19, 2017, which is incorporated herein byreference in its entirety.

TECHNICAL FIELD

The present disclosure is generally related to apparatuses, systems andmethods for computer-aided orthopedic surgery. More specifically, thepresent disclosure is related to automatically tracking and providingfeedback to a user regarding the position and orientation of a surgicaltool during a surgical procedure.

BACKGROUND

The use of computers, robotics, and imaging to aid orthopedic surgery isknown in the art. There has been a great deal of study and developmentof computer-aided navigation and robotic systems used to guide surgicalprocedures. For example, a precision freehand sculptor employs a roboticsurgery system to assist the surgeon in accurately cutting a bone into adesired shape. In procedures such as total hip replacement (THR) andtotal knee replacement (TKR), computer-aided surgery techniques havebeen used to improve the accuracy and reliability of the surgery.Orthopedic surgery guided by images has also been found useful inpreplanning and guiding the correct anatomical position of displacedbone fragments in fractures, along a good fixation by osteosynthesis.

Cut guides or cutting blocks can be used in an orthopedic surgicalprocedure to assist a surgeon in cutting or modifying some portions of atarget bone. For example, in joint replacement surgeries, such as THR orTKR, the preparation of the bones can involve temporarily affixing sawguide cutting blocks to the bones so that a reciprocating saw blade canbe held steady along its intended path. Placement of these blocks can beguided by manual instrumentation or through the use of jigs.

The positioning of cutting blocks can be a time consuming andcomplicated process, which is critical to positive outcomes for thepatient. Mechanisms that allow the cutting blocks to be adjusted withinthe required workspace are complex, and require high machiningtolerances, adding to the cost and complexity of these instrumentsystems. In some cases, pins can be inserted into a patient's bone inorder to provide an aligning mechanism for the cutting block. However,proper orientation and alignment of these pins becomes critical toproperly placing the cutting block itself.

Computer-assisted surgical tools to aid with pin placement have startedto become more prevalent. However, even these tools can lead toimprecise pin placement because the orientation and placement of the pindepends upon the user maintaining a drilling instrument at a properangle and drilling to a proper depth through the drilling process.Imprecision when drilling pin placement holes can lead to improperlyplaced cutting blocks. If the cutting blocks are improperly placed,improper bone cuts, implant placement, and joint replacements canresult.

SUMMARY

There is provided a system for tracking position and orientation of asurgical tool during a surgical procedure and providing feedback to auser. The system includes a surgical tool configured to perform at leasta portion of the surgical procedure, the surgical tool including atleast one tracking device, a tracking system configured to monitor theat least one tracking device and record position information related tothe at least one tracking device during the surgical procedure, aprocessing system operably connected to the tracking system, and adisplay operably connected to the processing system. The processingsystem is configured to receive the position information from thetracking system, determine optimal position information for the surgicaltool during the surgical procedure, compare the received positioninformation against the optimal position information to determine aconformance level for the user, and generate a user performance recordbased on at least a portion of the conformance level. The display isconfigured to receive the user performance record and display the userperformance record.

In some embodiments, the processing system is further configured todetermine an actual cutting rate for the surgical tool during thesurgical procedure, compare the actual cutting rate to an optimizedcutting rate for the surgical tool to determine a user cuttingperformance, and update the user performance record to include the usercutting performance.

In some embodiments, the surgical tool is a rotating cutting device. Insome additional embodiments, the processing system is further configuredto determine a rotational speed for the rotating cutting device duringthe surgical procedure, compare the rotational speed to an optimizedrotational speed for the rotating cutting device to determine a useroperational performance, and update the user performance record toinclude the user operational performance.

In some embodiments, the user performance record includes informationpertaining to the conformance level of one or more of a single surgicaltool operation during the surgical procedure, a plurality of tooloperations during the surgical procedure, and a plurality of tooloperations performed by the user during the surgical procedure.

In some embodiments, the at least one tracking device includes aplurality of optical markers. In some additional embodiments, theplurality of optical markers are arranged in a known position on thesurgical tool.

In some embodiments, the display is further configured to display theuser performance record as a graphical display.

There is also provided a method for tracking position and orientation ofa surgical tool during a surgical procedure and providing feedback to auser. The method includes monitoring, by a tracking system, at least onetracking device affixed to a surgical tool configured to perform atleast a portion of the surgical procedure; recording, by the trackingsystem, position information related to the at least one trackingdevice; receiving, by a processing system operably connected to thetracking system, the position information from the tracking system;determining, by the processing system, optimal position information forthe surgical tool during the surgical procedure; comparing, by theprocessing system, the received position information against the optimalposition information to determine a conformance level for the user;generating, by the processing system, a user performance record based onat least a portion of the conformance level; receiving, by a displayoperable connected to the processing system, the user performancerecord; and displaying, by the display, the user performance record.

In some embodiments, the method further includes: determining, by theprocessing system, an actual cutting rate for the surgical tool duringthe surgical procedure; comparing, by the processing system, the actualcutting rate to an optimized cutting rate for the surgical tool todetermine a user cutting performance; and updating, by the processingsystem, the user performance record to include the user cuttingperformance.

In some embodiments, the surgical tool is a rotating cutting device. Insome additional embodiments, the method further includes determining, bythe processing system, a rotational speed for the rotating cuttingdevice during the surgical procedure; comparing, by the processingsystem, the rotational speed to an optimized rotational speed for therotating cutting device to determine a user operational performance; andupdating, by the processing system, the user performance record toinclude the user operational performance.

In some embodiments, the user performance record includes informationpertaining to the conformance level of one or more of a single surgicaltool operation during the surgical procedure, a plurality of tooloperations during the surgical procedure, and a plurality of tooloperations performed by the user during the surgical procedure.

In some embodiments, the at least one tracking device includes aplurality of optical markers. In some additional embodiments, theplurality of optical markers are arranged in a known position on thesurgical tool.

In some embodiments, the method further includes displaying, by thedisplay, the user performance record as a graphical display.

There is also provided a system for providing feedback to a user duringa surgical procedure. The system includes a surgical tool configured toperform at least a portion of the surgical procedure and including atleast one tracking device, a tracking system configured to monitor theat least one tracking device and record information related to the atleast one tracking device during the surgical procedure, a processingsystem operably connected to the tracking system, and a display operablyconnected to the processing system. The processing system is configuredto receive the information from the tracking system, determine currentoperational information for the surgical tool, compare the currentoperational information against optimal operation information for thesurgical tool to determine a conformance level for the user, andgenerate a user performance record based on at least a portion of theconformance level. The display is configured to receive the userperformance record and display the user performance record.

In some embodiments, the processing system is further configured todetermine an actual cutting rate for the surgical tool during thesurgical procedure, compare the actual cutting rate to an optimizedcutting rate for the surgical tool to determine a user cuttingperformance, and update the user performance record to include the usercutting performance.

In some embodiments, the processing system is further configured todetermine actual position information for the surgical tool from theinformation received from the tracking system, determine optimalposition information for the surgical tool during the surgicalprocedure, compare the received position information against the optimalposition information to determine a user position performance, andupdate the user performance record to include the user positionperformance.

The example embodiments as described above can provide variousadvantages over prior techniques. For example, the techniques as taughtherein can more accurately provide real time feedback to a surgeonregarding their performance and efficiency during a surgical procedure.The techniques also provide for incentivizing a surgeon to improve theirefficiency during a surgical procedure.

Further features and advantages of at least some of the embodiments ofthe present disclosure, as well as the structure and operation ofvarious embodiments of the present disclosure, are described in detailbelow with reference to the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

Aspects, features, benefits and advantages of the embodiments describedherein will be apparent with regard to the following description,appended claims, and accompanying drawings where:

FIG. 1 depicts a simplified view of an illustrative optical surgicalnavigation setup during a joint replacement surgery in accordance withcertain embodiments.

FIG. 2 depicts an illustrative navigation system in accordance withcertain embodiments.

FIG. 3A depicts a perspective view of an embodiment of a handpiecehaving a plurality of markers attached thereto in accordance withcertain embodiments.

FIG. 3B depicts a plan view of a handpiece in an opened position havinga surgical tool positioned therein in an extended position in accordancewith certain embodiments.

FIG. 4 depicts a flow diagram of an illustrative method of automaticallytracking and providing feedback to a user regarding the position andorientation of a surgical tool during a surgical procedure in accordancewith certain embodiments.

FIGS. 5A-D depict illustrative displays for providing position trackinginformation in accordance with certain embodiments.

DETAILED DESCRIPTION

This disclosure is not limited to the particular systems, devices andmethods described, as these may vary. The terminology used in thedescription is for the purpose of describing the particular versions orembodiments only, and is not intended to limit the scope.

As used in this document, the singular forms “a,” “an,” and “the”include plural references unless the context clearly dictates otherwise.Unless defined otherwise, all technical and scientific terms used hereinhave the same meanings as commonly understood by one of ordinary skillin the art. Nothing in this disclosure is to be construed as anadmission that the embodiments described in this disclosure are notentitled to antedate such disclosure by virtue of prior invention. Asused in this document, the term “comprising” means “including, but notlimited to.”

For purposes of the description hereinafter, the terms “upper”, “lower”,“right”, “left”, “vertical”, “horizontal”, “top” “bottom”, “lateral”“longitudinal” and related derivatives thereof shall relate to theinvention as it is oriented in the drawing figures. However, it is to beunderstood that the present invention may assume various alternativevariations and step sequences, except where expressly specified to thecontrary. It is also to be understood that the specific devices andprocesses illustrated in the attached drawings, and described in thefollowing specification, are simply exemplary embodiments. For example,in the present disclosure, the surgical tool is described with respectto a surgical drill. However, any surgical tool on which a plurality ofmarkers may be placed can be used within the scope of this disclosure.Moreover, specific dimensions and other physical characteristics relatedto the embodiments disclosed herein are not to be considered as undulylimiting.

Optical navigation is used in surgery to track a rigid body's locationin space. FIG. 1 illustrates a simplified view of an illustrativesurgical navigation setup having a tracking system such as, for example,an infrared camera 10 and a tracker 12A having a plurality of markersthat may be used to perform surgical navigation. The tracker 12A may berigidly attached to any object 14 that the user/surgeon wishes to trackduring the surgical procedure. The tracker 12A may include a definedconfiguration of markers (35 as shown in FIG. 3), such as infraredreflective markers, for example. The camera 10 may continuously takepictures of the workspace during the surgical procedure, and the markers35 may be detected from those pictures. As will be understood by thoseof ordinary skill in the art, other position tracking systems may beused based on teachings of this disclosure including, but not limitedto, electromagnetic, inertial, hybrid, etc.

FIG. 2 depicts an illustrative navigation system 100 in accordance withcertain embodiments. As shown in FIG. 2, the navigation system 100 mayinclude an infrared camera 10, a processing system 9, and a displayterminal 16. Using the known rigid spatial relationship of the markers35 on the image frame obtained by the camera 10, the position (i.e., thelocation and orientation) of the object 14 in a 3D (three dimensional)space may be determined. The location of the object 14 may becontinuously output to the processing system 9 that integrates thislocation with patient anatomy positional information that may beobtained, for example, from a CT scan or ultrasound image. As such, adetermination of the location and orientation of the object 14 withrespect to a remainder or reference position of the patient anatomy maybe determined. The location and orientation of the object 14 relative tothe patient anatomy, such as a bone 17, may also be continuouslydisplayed on the display terminal 16. Thus, the user/surgeon may knowand understand the location of the object 14 in relation to the bone 17.

In an embodiment, the display terminal 16 may be used to providefeedback information regarding various aspects of the surgicalprocedure, such as the orientation of the object 14. Further, theprocessing system 9 of the navigation system 100 may be used todetermine the position and orientation of the object 14 with respect toa patient in substantially real time. Additional features anddescription of the detection and/or navigation system 100 may be foundin, for example, U.S. Pat. Nos. 6,757,582 and 8,961,536, both of whichare incorporated herein by reference in their entireties.

FIG. 3A illustrates the tracker 12A, with tracker frame 34 and markers35 rigidly attached to a rigid object to be tracked, such as a handpiece15, for example. The tracking of the handpiece 15 allows the navigationsystem 100 to know the position of a distal end 22 of a drill 20 whenthe drill is inserted into the handpiece 15. In certain implementations,the tracker frame 34 may be relatively large as compared to the distalend 22 of the drill 20. Similar trackers, such as 12B, may be mounted,for example, on the bone 17 being operated on as shown in FIG. 1.

Display software may be used to project the geometry of the trackedobject 14, such as, for example, the drill 20 having handpiece 15thereon, on the display screen 16 so that a virtual, real-time image ofthe object 14 and the surrounding anatomy of the patient bone 17 can bemade available to the user/surgeon to aid in the surgery. A virtualinterface 16 may depict the tracked tool 20 within the handpiece 15 ingeometrical relationship with the tracked anatomy 17 of a patient. Thisinterface 16 may remain visible to the user/surgeon during a surgicalprocedure. It is understood that multiple objects may be tracked,including rigid patient anatomy, such as the bone 17, in the sameworkspace with the same camera 10. However, each tracked object or partof a patient's anatomy should have its own tracker frame/array and theconfiguration of the markers should be unique for each object so as toenable the software, or any other computer processor analyzing imagedata, to distinguish between objects based on their respective trackers.

FIG. 3B depicts a side view of an opened handpiece 15 with the tracker12A attached thereto with mounting members 13 and the drill 20 insertedin a partially extended position therein. When the drill 20 is insertedinto the handpiece 15, the distal end 22 and a proximal end of the drill20 may each be in a fixed position with respect to the markers 35 of thetracker 12A because of the rigid attachment of the marker frame 34 tothe handpiece. As such, a location of the distal end 22 and the proximalend of the drill 20 may be determined by the processing system 9.

The handpiece 15 may include a modular guard 26 to control exposure ofthe distal end 22 of a drill 20 inserted into the handpiece. The outerhousing of the handpiece may include a locking mechanism 50 for easyattachment and detachment of the modular guard 26.

Although the markers described above depict a tracker frame 34 havingmarkers 35 attached thereto in a known configuration, alternateconfigurations of markers may be used. For example, at least one distalmarker may be placed on or near a distal end of a drill and at least oneproximal marker may be placed on or near a proximal end of the drill.The at least one distal marker and the at least one proximal marker maybe placed directly on the drill in a known configuration. In analternate embodiment, the at least one distal marker and the at leastone proximal marker may be placed on a handpiece in a knownconfiguration. Other marker configurations may also be used within thescope of this disclosure.

In some embodiments, information pertaining to the orientation andposition of a surgical tool may be useful to a surgeon performing asurgical procedure. For example, when the surgeon is performing adrilling operation using a drill 20, the surgeon or others may beinterested in determining whether the hole being drilled is in theproper position, at the proper orientation, drilled to the proper depth,or the like.

FIG. 4 depicts a flow diagram of an illustrative method of automaticallytracking and providing feedback to a user regarding the position andorientation of a surgical tool during a surgical procedure in accordancewith certain embodiments. As shown in FIG. 4, a surgical tool, such as adrill, may be placed 405 in a handpiece prior to performing a surgicaloperation, such as a drilling operation. The handpiece may be similar tothe ones described above in reference to FIGS. 3A and 3B or any otherhandpiece that is able to be tracked via a navigation system, such asthe one described above in reference to FIG. 2.

The locations of the distal and proximal ends of the surgical tool maybe detected 410 using the tracking system. For example, the trackingsystem may detect 410 the location of the markers on a tracking frameattached to the handpiece. Based on pre-programmed informationpertaining to the relative sizes and positions of the handpiece, thedrill and the markers on the tracking frame, a location of a distal endof the drill and a proximal end of the drill in three dimensional spacemay be determined. Methods of determining a location of a distal end anda proximal end of a surgical tool will be apparent to those of ordinaryskill in the art based on this disclosure.

The locations of the distal and proximal ends of the surgical tool maybe displayed 415 on a display terminal. For example, the displayterminal may display 415 graphical or alphanumerical informationpertaining to the locations of the distal and proximal ends of thesurgical tool with respect to a point in three dimensional space atwhich a drilling operation is to commence. Further information regardingdisplaying 415 the locations of the distal and proximal ends of thesurgical tool are disclosed below in reference to FIGS. 5A-D.

The surgical tool may be aligned 420 to perform a surgical operation.For example, the user may review the information displayed 415 on thedisplay terminal and use the information as a guide to align 420 thesurgical tool before commencing the surgical operation. For example, theuser may manipulate the position and orientation of the surgical tool toalign displayed indicators representing the distal and proximal ends ofthe surgical tool, thereby indicating that the tool is aligned at aproper angle for performing the surgical operation.

As the surgical operation is being performed, location informationpertaining to the distal end and the proximal end of the surgical toolmay be recorded 425. In an embodiment, the location information may begraphically displayed on the display terminal as part of the recordingprocess 425.

Information pertaining to the surgical operation may be stored 430 in adatabase or other similar data structure. For example, the informationmay include the locations of the distal end and the proximal end of thesurgical tool throughout the surgical operation, assessment informationregarding the accuracy of the user when performing the surgicaloperation, historical accuracy information regarding the user and/or oneor more other users, or the like. Further examples of the types ofinformation that may be stored are discussed below in reference to FIGS.5A-D.

FIGS. 5A-D depict illustrative displays for providing position trackinginformation in accordance with certain embodiments. As shown in FIG. 5A,the display screen 16 may display a representation 500 of the trackedobjects within the surgical space. Within the displayed representation500, the display screen 16 may include directional axes 502A,Bidentifying a position at which a drill hole should be placed at theirintersection 504. In addition, the displayed representation 500 mayinclude a first crosshair 506 representative of the location of thedistal end of the drill and a second crosshair 508 representative of thelocation of the proximal end of the drill. If the position of the drill(as represented by the distal end and the proximal end) is perfectlyaligned to drill a particular hole, both of the crosshairs 506, 508 maybe coincident with the intersection point 504 of the directional axes502A,B. Alternate signifiers may be used in place of the crosshairs 506,508 as will be apparent to one of ordinary skill in the art based onthis disclosure.

When a drilling operation commences, the displayed representation 500may identify the position of the distal end of the drill and theproximal end of the drill at various points in time. For example, asshown in FIG. 5B, the displayed representation may include a first mark510 representing the location of the distal end of the drill at the timethat the drilling operation commenced and a second mark 512 representingthe location of the proximal end of the drill at the time that thedrilling operation commenced. Although the marks 510, 512 are shown indifferent shading in FIG. 5B, it will be apparent to one of ordinaryskill in the art that the marks may differ in color, shade, shape, styleor any other distinguishing feature to allow a user to identify whethera mark was placed based on the location of the distal end or thelocation of the proximal end during the drilling operation.

As shown in FIG. 5C, during the drilling operation a plurality oflocations may be recorded for each of the distal end of the drill andthe proximal end of the drill in the displayed representation 500. In anembodiment, a mark may be recorded for each of the distal end of thedrill and the proximal end of the drill at a determined time interval.For example, a mark may be recorded for each of the distal end of thedrill and the proximal end of the drill at a determined time interval ofabout 1 microsecond (μs), about 10 μs, about 20 μs, about 50 μs, about100 μs, about 200 μs, about 500 μs, about 1 millisecond (ms), about 2ms, about 5 ms, about 10 ms, about 20 ms, about 50 ms, about 100 ms,about 200 ms, about 500 ms, or about 1 second, or within a time intervalbounded by any two of the aforementioned time periods.

In an embodiment, the location of the distal end of the drill and theproximal end of the drill during the drilling operation may berepresented as discrete points as in FIG. 5C. In an alternateembodiment, the location of the distal end of the drill and the proximalend of the drill during the drilling operation may be represented as acontinuous path. Other methods of displaying the locations of the distaland proximal ends of the drill will be apparent to one of ordinary skillin the art based on this disclosure.

FIG. 5D depicts a final assessment screen for a surgical procedure. Asshown in FIG. 5D, graphs 520A-D of the distal end of the drill and theproximal end of the drill for each of a plurality of drilling operationsmay be displayed in the displayed representation 500. In an embodiment,a diagram of the particular drilling positions 522A-D and a drillingguide may be displayed in the displayed representation 500 as well. Inan embodiment, feedback information 524 may be provided to the user asan assessment of the accuracy of their drilling as compared to an idealdrilling operation.

The feedback information 524 may be presented to the user during thesurgical operation. In addition, the feedback information 524 may berecorded in a database entry associated with the user to assess theuser's performance. For example, the feedback information 524 may beused by the user, a supervisor, a vendor, a manufacturer, or any otherindividual or entity to assess performance of the user as compared toother users and/or as compared to the user's past performance. In thismanner, the user may be incentivized to increase their proficiency basedon such comparison. In addition, incentives may be provided to usersthat are the most accurate across a plurality of surgical procedures, orto users that show the most improvement in their accuracy in a givenperiod of time.

In certain implementations, to improve efficiency during a surgicalprocedure, the surgeon may be incentivized to maintain particular levelsof performance during a surgical procedure. For example, when burring,the feedback information 524 may also include a scale or meter thatprovides a visual indication of real-time performance. The meter mayreflect, for example, a readout indicative of the amount of material thesurgeon is removing for a given time period. For example, when planninga surgical procedure, the amount of bone to be removed may be measuredin voxels included on a 3D representation of the bone. The feedbackinformation 524 may include, for example, a VPM meter showing ameasurement of voxels per minute that the surgeon is removing, similarto a miles per gallon fuel measurement included in vehicles that areintended to promote more efficient driving. For a specific cut, theremay be an optimized cutting rate that combines high accuracy with highefficiency. By providing feedback showing how close a surgeon is tohitting that optimized cutting rate, the surgeon may be moreincentivized to maintain their cutting speed as close to the optimizedcutting rate as possible.

Similarly, the feedback information 524 can include a measurement of therotational speed of the cutting bur. For example, for a particular bur,there may be an optimal rotational speed for optimal cutting. Thefeedback information 524 can provide an indication as to whether the buris rotating too slowly (resulting in inefficient cuts) or too fast(potentially resulting in inaccurate cuts).

Results directed to both the optimized cutting rate of bone as well asoperating the cutting tool at an optimal speed can be collected asdescribed above and included when determining a final score for asurgeon during a procedure. As such, both the optimized cutting rate ofbone as well as operating the cutting tool at an optimal speed can beimportant factors for incentivizing a surgeon to improve theirperformance during a surgical procedure, thereby improving theirefficiency and potential earnings.

In the above detailed description, reference is made to the accompanyingdrawings, which form a part hereof. In the drawings, similar symbolstypically identify similar components, unless context dictatesotherwise. The illustrative embodiments described in the detaileddescription, drawings, and claims are not meant to be limiting. Otherembodiments may be used, and other changes may be made, withoutdeparting from the spirit or scope of the subject matter presentedherein. It will be readily understood that the aspects of the presentdisclosure, as generally described herein, and illustrated in theFigures, can be arranged, substituted, combined, separated, and designedin a wide variety of different configurations, all of which areexplicitly contemplated herein.

The present disclosure is not to be limited in terms of the particularembodiments described in this application, which are intended asillustrations of various aspects. Many modifications and variations canbe made without departing from its spirit and scope, as will be apparentto those skilled in the art. Functionally equivalent methods andapparatuses within the scope of the disclosure, in addition to thoseenumerated herein, will be apparent to those skilled in the art from theforegoing descriptions. Such modifications and variations are intendedto fall within the scope of the appended claims. The present disclosureis to be limited only by the terms of the appended claims, along withthe full scope of equivalents to which such claims are entitled. It isto be understood that this disclosure is not limited to particularmethods, reagents, compounds, compositions or biological systems, whichcan, of course, vary. It is also to be understood that the terminologyused herein is for the purpose of describing particular embodimentsonly, and is not intended to be limiting.

With respect to the use of substantially any plural and/or singularterms herein, those having skill in the art can translate from theplural to the singular and/or from the singular to the plural as isappropriate to the context and/or application. The varioussingular/plural permutations may be expressly set forth herein for sakeof clarity.

It will be understood by those within the art that, in general, termsused herein, and especially in the appended claims (for example, bodiesof the appended claims) are generally intended as “open” terms (forexample, the term “including” should be interpreted as “including butnot limited to,” the term “having” should be interpreted as “having atleast,” the term “includes” should be interpreted as “includes but isnot limited to,” et cetera). While various compositions, methods, anddevices are described in terms of “comprising” various components orsteps (interpreted as meaning “including, but not limited to”), thecompositions, methods, and devices can also “consist essentially of” or“consist of” the various components and steps, and such terminologyshould be interpreted as defining essentially closed-member groups. Itwill be further understood by those within the art that if a specificnumber of an introduced claim recitation is intended, such an intentwill be explicitly recited in the claim, and in the absence of suchrecitation no such intent is present.

For example, as an aid to understanding, the following appended claimsmay contain usage of the introductory phrases “at least one” and “one ormore” to introduce claim recitations. However, the use of such phrasesshould not be construed to imply that the introduction of a claimrecitation by the indefinite articles “a” or “an” limits any particularclaim containing such introduced claim recitation to embodimentscontaining only one such recitation, even when the same claim includesthe introductory phrases “one or more” or “at least one” and indefinitearticles such as “a” or “an” (for example, “a” and/or “an” should beinterpreted to mean “at least one” or “one or more”); the same holdstrue for the use of definite articles used to introduce claimrecitations.

In addition, even if a specific number of an introduced claim recitationis explicitly recited, those skilled in the art will recognize that suchrecitation should be interpreted to mean at least the recited number(for example, the bare recitation of “two recitations,” without othermodifiers, means at least two recitations, or two or more recitations).Furthermore, in those instances where a convention analogous to “atleast one of A, B, and C, et cetera” is used, in general such aconstruction is intended in the sense one having skill in the art wouldunderstand the convention (for example, “a system having at least one ofA, B, and C” would include but not be limited to systems that have Aalone, B alone, C alone, A and B together, A and C together, B and Ctogether, and/or A, B, and C together, et cetera). In those instanceswhere a convention analogous to “at least one of A, B, or C, et cetera”is used, in general such a construction is intended in the sense onehaving skill in the art would understand the convention (for example, “asystem having at least one of A, B, or C” would include but not belimited to systems that have A alone, B alone, C alone, A and Btogether, A and C together, B and C together, and/or A, B, and Ctogether, et cetera). It will be further understood by those within theart that virtually any disjunctive word and/or phrase presenting two ormore alternative terms, whether in the description, claims, or drawings,should be understood to contemplate the possibilities of including oneof the terms, either of the terms, or both terms. For example, thephrase “A or B” will be understood to include the possibilities of “A”or “B” or “A and B.”

In addition, where features or aspects of the disclosure are describedin terms of Markush groups, those skilled in the art will recognize thatthe disclosure is also thereby described in terms of any individualmember or subgroup of members of the Markush group.

As will be understood by one skilled in the art, for any and allpurposes, such as in terms of providing a written description, allranges disclosed herein also encompass any and all possible subrangesand combinations of subranges thereof. Any listed range can be easilyrecognized as sufficiently describing and enabling the same range beingbroken down into at least equal halves, thirds, quarters, fifths,tenths, et cetera. As a non-limiting example, each range discussedherein can be readily broken down into a lower third, middle third andupper third, et cetera. As will also be understood by one skilled in theart all language such as “up to,” “at least,” and the like include thenumber recited and refer to ranges that can be subsequently broken downinto subranges as discussed above. Finally, as will be understood by oneskilled in the art, a range includes each individual member. Thus, forexample, a group having 1-3 cells refers to groups having 1, 2, or 3cells. Similarly, a group having 1-5 cells refers to groups having 1, 2,3, 4, or 5 cells, and so forth.

Various of the above-disclosed and other features and functions, oralternatives thereof, may be combined into many other different systemsor applications. Various presently unforeseen or unanticipatedalternatives, modifications, variations or improvements therein may besubsequently made by those skilled in the art, each of which is alsointended to be encompassed by the disclosed embodiments.

What is claimed is:
 1. A method for tracking position and orientation ofa surgical tool having distal and proximal ends during a surgicalprocedure and providing feedback to a user, the method comprising:receiving, by a processing system operably connected to a trackingsystem, position information for at least one tracking device affixed tothe surgical tool from the tracking system; determining, by theprocessing system, a location for the distal end and the proximal end ofthe surgical tool in three-dimensional space based on the receivedposition information for the at least one tracking device to identifythe position and orientation of the surgical tool; comparing, by theprocessing system, the identified position and orientation of thesurgical tool to optimal position and orientation data to determine aconformance level for the user for the surgical procedure; andgenerating, by the processing system, a user performance record based onat least a portion of the conformance level.
 2. The method of claim 1,further comprising: determining, by the processing system, an actualcutting rate for the surgical tool during the surgical procedure;comparing, by the processing system, the actual cutting rate to anoptimized cutting rate for the surgical tool to determine a user cuttingperformance; and updating, by the processing system, the userperformance record to include the user cutting performance.
 3. Themethod of claim 1, wherein the surgical tool is a rotating cuttingdevice.
 4. The method of claim 3, further comprising: determining, bythe processing system, a rotational speed for the rotating cuttingdevice during the surgical procedure; comparing, by the processingsystem, the rotational speed to an optimized rotational speed for therotating cutting device to determine a user operational performance; andupdating, by the processing system, the user performance record toinclude the user operational performance.
 5. The method of claim 1,wherein the user performance record comprises information pertaining tothe conformance level of one or more of a single surgical tool operationduring the surgical procedure, a plurality of tool operations during thesurgical procedure, and a plurality of tool operations performed by theuser during the surgical procedure.
 6. The method of claim 1, whereinthe at least one tracking device comprises a plurality of opticalmarkers.
 7. The method of claim 6, wherein the plurality of opticalmarkers are arranged in a known position on the surgical tool.
 8. Themethod of claim 1, further comprising displaying, by the display, theuser performance record as a graphical display.